Did I Hear You Say There's a "Mass"?

Earlier this week I received a worrisome inquiry on the WebMD Eye & Vision Disorder message board. A woman expressed grave concern because her ophthalmologist informed her that she had a mass - a retro-orbital mass.

Don't let words frighten you.

The best way to defuse retro-orbital mass is to break it down. Retro/orbital means "behind the eyeball" and inside the orbital cavity. Of course, it's the word "mass" that really got her attention.

Mass...tumor....growth...lesion....aren't they just pretty words for CANCER?

The simple answer is "No!"

There are all kinds of lumps that can appear in the orbit, including some that are present since birth.

• A mass is simply a collection of matter. It could be cells, blood vessels, even a chunk of calcium. Most masses are not cancerous.
• A growth is a mass that has enlarged. An inflamed zit qualifies as a growth.
• Tumor is Latin for swelling. Technically, a swollen, sprained ankle (like the one I'm nursing today) is a tumor. See? Not all tumors are cancerous.
• Lesion refers to abnormal looking tissue: infection, inflammation, trauma, many causes.

Most of the time a newly discovered lump in the orbit is not cancerous. 70% of all acquired orbital masses are noncancerous cysts.

What about the other 30%? Most are treatable vascular growths or soft tissue inflammation. Truth be told, cancer originating behind the eyeball is quite rare and when it does occur it usually responds well to the prescribed treatment. One sad exception is metastatic cancer that began somewhere else (lung, breast, colon, etc.), but at that point the individual is already aware of their plight.

So it is worth repeating. Do not be intimidated by words - especially medical terminology. Probe your doctors for clear, precise answers and don't hesitate to check back with us afterwards. At WebMD we speak the language of accuracy and encouragement.

Related Topics:

• Getting the Most from Your Doctor’s Appointment
• Work Closely With Your Doctor

Technorati Tags: eye, mass, tumor, cancer, health and wellness

What Is The Opposite of GLAUCOMA?

Most adults are aware that elevated intraocular pressure (IOP) contributes to the permanent vision loss in glaucoma. Most glaucoma treatments (medication, laser, surgery) are directed at lowering IOP. Yes, there are other glaucoma risk factors but lowering IOP is the only controllable risk factor.

Much discussion is spent on the 'ideal IOP', the 'borderline IOP', and the 'dangerous IOP'. What about the abnormally low IOP? Intuitively it sounds like the opposite of glaucoma and, therefore, a good thing. A good thing? Not so fast, Martha!

Consider this, normal body temperature is 98.6F and 103F is a fever. 93F is hypothermia, a life-threatening medical emergency. Looking at it another way, the normal air pressure in a bicycle tire is 65psi, the tube may burst at 115psi, but you will definitely not enjoy riding on 10psi tires!

The medical term for low IOP is hypotony (say high-POT-oh-nee). Persistent low pressure can cause serious changes inside the eye that can destroy vision. Hypotony often develops after eye surgery but typically resolves once healing is completed. Severe trauma, inflammation and infection can abnormally lower the IOP. Chronic hypotony can lead to blindness.

Treating the underlying cause for low IOP will usually restore the pressure back to the normal range. I was prompted to post this blog after receiving an inquiry about hypotony on the WebMD Vision & Eye Disorder Member Board. If you have eye questions regarding yourself or a loved one I hope you will meet me there!

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• WebMD Video: Are You at Risk for Glaucoma?
• WebMD Video: Spotting Eye Disease with Screening at the Mall

Technorati Tags: glaucoma, IOP, low IOP, eye health

Sniffles and Pediatric Surgery

Pediatric surgeons plan liberally. They schedule 10 surgery cases in hopes that 6 can be completed.

Pedi surgery cases cancel more frequently than adult surgery. Parents have all kinds of challenges: arranging transportation, getting time-off from work, and keeping the child from eating or drinking anything for 6 hours (good luck!).

The most common cause for cancellation is that the child is too sick to undergo the operation. How ironic! Most of the time it is something minor like a cold or ear infection. Since children receiving eye surgery require general anesthesia delivered by tracheal intubation, the child's airways must be healthy and noninflamed. Any kind of residual swelling or airway restriction could have devastating consequences.

Every hospital sets its own rules but many require the child to not have any type of upper respiratory infection for 14 days prior to general anesthesia. The same applies to asthma attacks as well. Fever is not the indicator, it is the clarity of the breathing passages. Delicate bronchioles are very sensitive after illness and could go into bronchospasm if challenged by poorly-timed anesthesia. Healthy children have died because the anesthetist was unaware of a child's recent respiratory illness.

Don't become upset if your child's surgery gets postponed. Be grateful that someone is looking out for the safety of your child. There's a big difference between inconvenience and tragedy, right? They'll get their operation soon enough.

Be proactive. Call the doctor today if your child is scheduled for surgery in the next 14 days and presently has a cold or earache. A prudent, timely decision can be made now and lost time-off can be saved for later use.

Related Topics:

• WebMD Video: When to Call the Pediatrician
• Is it a Cold or the Flu?

Technorati Tags: health, wellness, surgery, pediatrics, cold, flu

False Assumptions: What Keeps You Away from the Eye Doctor?

This week I'm in New Orleans attending the Annual Meeting of the American Academy of Ophthalmology. The last time AAO was here was 2004, pre-Katrina. In 2007 less than half of the membership is here. In fact, it appears that more international members are attending. That is an enormous drop from last year's meeting in Las Vegas that hosted over 21,000 registrants.

People just make assumptions about New Orleans: there's no place to stay, the airport is still closed (incredible as it sounds, some believe that although the airport reopened right after Katrina passed through!), crime is rampant. Incorrect assumptions often lead to disastrous results. A lot of time and money was invested in this medical convention for which many folks decided to stay home.

I bring this up because a new report shows that eye doctors make lots of incorrect assumptions regarding their patients. If asked why patients fail to make/keep follow-up appointments most doctors might assume it has something to do with the expense of eye care or perhaps anxiety about the eye exam. Nonsense! The number one reason folks don't keep appointments with their eye doctor is lack of transportation. Guess what? Parking availability has a lot to do with it, too! So do things like inconvenient office hours and waiting rooms that are too cold!

It appears that patients genuinely want to receive the eye care they need. It's just that nonmedical factors create obstacles to receiving that care - very fixable obstacles.

Your local eye specialist and clinic staff are likely operating under many incorrect assumptions. Ask your eye doctor to find a vacant clinic parking space (other than the reserved doctor's space!) Ask the nurse supervisor to sit in the waiting room for 90-minutes without getting frostbite.

Assumptions find their way into every aspect of medical care. Doctors may assume the patient can't understand the specific details about their eye problem (...hello, WebMD), surgeons may assume the patient cannot hear what is being discussed in the operating room (the patients are sedated - not unconscious!), and the fatal assumption that the patient is very satisfied since they have said nothing critical.

Memo to all physicians: If you really want to know how your patient feels about something (anything) all you have to do is ask. This one time your assumption will be correct because they will tell you what's on their mind!

Remember, New Orleans International Airport is open and fully operational. Come visit soon!

REFERENCE: Karmel M: "Out of Earshot - What Patients Say About Their Eye Care." EyeNet Magazine. November 2007.

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• Choosing an Eye Doctor
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Technorati Tags: eye exam, vision, eye doctor

Pinkeye Timeline: When Is It Safe to Resume School?

1 in 8 USA students develop pinkeye every year: that's 5 million cases. Most infectious pinkeye cases are caused by the common cold virus and, like the cold, its signs and symptoms will resolve in 5-7 days.

Read my previous blog entry to discover how to identify the most common types of pinkeye.

During the period of active viral infection the disease is highly contagious. Improper/absent hand washing is most frequently blamed for pinkeye transmission. Contaminated fingertips inoculate surfaces and other people.

Elementary schools and daycare centers are very sensitive to problems caused by a pinkeye breakout - mostly because if a teacher contracts pinkeye other staff will need to double-up to cover the absence.

Truth be told, like other viral infections, the contagiousness of pinkeye is at its peak long before the child's eye becomes inflamed. Forced quarantine at home does little on Day 3 or 4 of the infection. In order to be effective, school nurses would have to be psychic and know which students will develop pinkeye in the preceding days. Given that skill, they ought to be buying lottery tickets!

School systems and daycare organizations have developed all kinds of stay-at-home policies for children with pinkeye. Most are modeled after a bacterial epidemic - so long as you are making pus you likely remain contagious. Unfortunately, most cases of pinkeye are viral and behave differently. WebMD is not going to challenge the bureaucracy - just know that by Day 5 the child with viral pinkeye is no longer contagious.

Don't be too concerned about redness. This is hyperemia, inflamed tissues that persist long after the virus has departed. The eye might appear pink/red for another week.

As always, contact your family physician if your child exhibits atypical pinkeye symptoms that alarm you: eye pain, severe redness, excessive discharge, drop in visual acuity.

Related Topics:

• Keeping Catchy Infections Contained
• Hand Washing 101

Technorati Tags: pinkeye, conjunctivitis, vision

Pinkeye and Other Mysteries of Eye Goop Revealed!

Yecchhh! What is this stuff?

Adult or child, the presence of any kind of discharge oozing out of the eye is alarming.

Here are some things to consider whenever you discover crud around the eyes:

First, it's important to determine if there is any kind of eye emergency. Eye pain, severe redness or abrupt change in vision are signals to contact your eye doctor. This advice is DOUBLY IMPORTANT if you wear contact lenses or if you have had recent eye surgery.

Now, let's say the eye is white and quiet, the vision is good, and there is no eye discomfort. What do you do about the goop? Let's break it down.

A discharge from the eye can be infectious (bacteria, viral, fungal, etc.) or noninfectious (other causes).

Pinkeye (conjunctivitis) is the most common cause of goopy eye discharges.

It's wise to assume pinkeye is infectious until definitively diagnosed by a health care provider. That means scrupulous handwashing for everyone!

• Bacterial: heavy pus-like material, one or both eyes


• Viral: Clear and watery, starts first in one eye, may feel swollen lymph node near 'sideburns' area in front of ears

Noninfectious causes are usually very fixable.

• Allergic: Watery, both eyes are very itchy, eyelid lid swelling


• Tear duct obstruction: Usually seen in infants, goop expresses with gentle pressure along inner corner of the eye


• Dry eyes: Inadequate water in tear film leads to excess mucus, rubbery strands of goop

Until you can get medical care, use a clean moist washcloth to wipe away the crud. Preservative-free artificial tears will make the eyes more comfortable - just be sure not to share the eyedrop container, right?

Next time we'll learn more about incubation times and pinkeye contagion (how soon before a child can return to school).

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• Is it Pinkeye? Check Your Symptoms
• How to Avoid Itchy, Watery Eyes

Technorati Tags: eye pain, pinkeye, conjunctivitis, itchy eye, eye discharge, goopy eyes

Hidden Bonus with Combination Drugs

Seen the commercials for the single pill with two ingredients that controls both high blood pressure and high cholesterol? Well, ocular pharmaceutical firms are following that innovative example.

For the first time, two familiar prescription eyedrops used to treat Primary Open Angle Glaucoma (POAG) have been combined into one formula. Separately, each of these drops have successfully reduced elevated intraocular pressure, so why is this news?

The new product is called Combigan and it is marketed by drug maker Allergan. Combigan is made up of two active compounds: brimonidine and timolol. Brimonidine is an alpha-agonist and timolol is a beta-blocker. That means each anti-glaucoma drug has a separate mechanism of action, they lower the pressure differently.

That's a good thing because over time glaucoma eyedrops tend to lose their effectiveness compared to when the drug is first used. After 6-12 months the pressure may begin to creep upward so the prescribing doctor usually stops one eyedrop and substitutes a different drug. Typically there is a dramatic recovery of good pressure control that lasts another 6-12 months. At that point the doctor may need to prescribe two eyedrops.

Asking a patient to take one eyedrop three times a day and instill a second eyedrop twice a day - all at different hours - is an enormous challenge. There are serious problems with patient compliance because life gets in the way. It's just too hard to accurately administer eyedrops five times every day and keep things straight.

Combigan is prescribed for twice a day use. FDA-reviewed clinical studies reported that the pressure lowering effect of Combigan, as expected, was better than each drug alone and almost as good compared to study volunteers who succeeded in using the two separate drugs. (Study volunteers are often provided assistance, even money, to take all of their medications. Real-world medical care is very different. Nobody will call you every day to remind you to take your eyedrops, right?)

Because these two preparations have been used for many years by millions of patients there is a well-established safety record - another good thing!

The introduction of Combigan is an important advance in the medical treatment of glaucoma because we already know these compounds work, their pressure-lowering effect is enhanced when combined, and difficult problems with patient compliance are significantly reduced. Most folks can handle a twice-a-day eyedrop.

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• WebMD Video: Age-Related Vision Loss
• WebMD Video: Tips for Better Vision

Technorati Tags: glaucoma, vision, combigan, eyedrops, health and wellness

Is There A Deadline for Post-op Success?

**FLASH** Medical Bulletin: Surgery is not like the car repair shop. For starters, there is a lot more hand washing going on in the eye clinic! When you pickup your 1994 four-door from the service center you pay the bill and drive away. It's as good as it's ever going to be the moment you drive away.

The recovery period from eye surgery is very different. Patients often see worse immediately after eye surgery. There are many explanations and thing usually clear rapidly. Mild swelling of the outermost corneal epithelial cells is a familiar culprit. Once you are up and about (and blinking regularly) visual clarity quickly returns.

If you have had cataract or corneal surgery there may be an issue with astigmatism. Creating and closing a surgical incision can create some irregularities to the corneal curvature. Placing sutures is another contributor. Again, time, natural healing, and proper use of postoperative medications will make things right.

Now, what about eye muscle surgery - strabismus surgery?

During a strabismus procedure the surgeon loosens, lengthens, tightens, or relocates one or more of the 6 extraocular muscles that move each eyeball. The amount of adjustment is an estimate based on averages based on many thousands of similar procedures. Many eye muscle surgery patients experience double vision (diplopia) but there is no cause for alarm. So long as the two eyes are reasonably aligned following surgery the brain will take over and fuse the images. It might take a few weeks so temporary prism glasses may be prescribed to help the individual function with minimal symptoms.

What happens if symptoms persist after eye surgery?

Three months is a good standard. Surgeons are reluctant to re-operate during the first three months because they know that inflammation will eventually subside and the body's own healing powers will have a full opportunity to work their magic. Rushing in too early could lead to an overcorrection and that might require a third operation (read cranky patient!)

Remember, if things are not perfect immediately following eye surgery there is likely a good reason. That does not automatically mean a complication has occurred. Most of the time it is simply a matter of time before things improve. In the meantime keep washing your hands regularly!

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• LASIK Eye Surgery and Other Refractive Surgeries: An Updated Guide
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Technorati Tags: eye surgery, vision, post-op, health and wellness